1/11. Neurological deficit following spinal anaesthesia: MRI and CT evidence of spinal cord gas embolism.A 62-year-old diabetic woman developed permanent neurological deficits in the legs following spinal anaesthesia. MRI showed oedema in the spinal cord and a small intramedullary focus of signal void at the T10 level, with negative density at CT. Intramedullary gas bubbles have not been reported previously among the possible neurological complications of spinal anaesthesia; a combined ischaemic/embolic mechanism is hypothesised.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/11. latex allergy in dentistry. review and report of case presenting as a serious reaction to latex dental dam.latex allergy may have severe consequences including development of anaphylaxis. This report describes a patient who underwent a reaction to latex dental dam manifesting as erythema, facial swelling and mild airway compromise. Restorative procedures under latex dental dam were performed under local anaesthesia on two occasions resulting in reactions of increasing severity. Following the first event the cause of the reaction was undetermined, but attributed to a possible allergy to local anaesthetic, and managed with corticosteroids and antihistamines. On a subsequent occasion the swelling was more severe, associated with difficulty in swallowing and mild airway compromise, and was managed as previously with adrenaline also being required. latex allergy was subsequently confirmed.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
3/11. Upper airway oedema following autologous blood transfusion from a wound drainage system.We report a case of a 70-yr-old white woman who underwent a revision of a total hip arthroplasty under general anaesthesia. The intraoperative course was stable without any complications and the estimated blood loss was 2500 ml. The patient received an autologous transfusion of blood from a wound drainage system in the recovery room. The transfusion was followed immediately by marked respiratory distress and upper airway oedema. She required emergency tracheal intubation and mechanical pulmonary ventilation. A coagulopathy also developed which was treated and resolved within 12 hr of the capillary leak phenomenon. The trachea was extubated on the first postoperative day and she had an uneventful course until discharge from the hospital two days later. We discuss the possible, aetiology of such a reaction to autologous blood including complement and platelet activation. It is suggested that reinfusion of nonwashed shed blood from a wound drainage system may present a hazard even though the fluid was autologous in origin.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
4/11. Laryngeal oedema as an obstetric anaesthesia complication: case reports.Three cases of laryngeal oedema leading to endotracheal intubation difficulties in obstetric anaesthesia are described. The first case occurred immediately postpartum in a patient who developed a swollen face from strenuous bearing down efforts in the second stage of labour. The other two cases were patients with severe preeclampsia including marked generalized oedema. The possibility of the occurrence of laryngeal oedema with resultant endotracheal intubation difficulties in obstetrics should be remembered when endotracheal intubation is considered to avoid the hazard of acid aspiration. The authors prefer the use of regional anaesthetic techniques (if not contraindicated) in obstetrics, and emphasize the use of prophylactic methods to minimize the risk of acid aspiration in connection with general anaesthesia, particularly where endotracheal intubation may be difficult.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/11. Changing Mallampati score during labour.We present the case of a changing Mallampati score during the course of labour in a healthy primigravida. On admission to hospital, the airway was assessed as Mallampati class I-II. At 5 cm cervical dilation, the woman began to bear down strenuously and continued this despite being advised of the inherent hazard. At 8 cm dilation, Caesarean delivery was contemplated because of fetal heart rate decelerations. Repeat airway evaluation revealed marked oedema of the lower pharynx giving rise to a Mallampati score of III-IV. Improvement of the fetal heart rate tracing permitted vaginal delivery under local infiltration. Postpartum, the Mallampati score was still III-IV. However, 12 hr later it had returned to the admission classification of I-II. We recommend that, in addition to the usual airway evaluation on admission, the assessment be repeated in the obstetric patient before induction of general anaesthesia.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
6/11. Preoperative marijuana inhalation--an airway concern.PURPOSE: cannabis Sativa (marijuana) may cause a variety of respiratory disorders including uvular oedema. This case illustrates that uvular oedema secondary to marijuana inhalation may cause a potentially serious postoperative clinical problem. CLINICAL FEATURES: A healthy 17-yr-old man who inhaled marijuana prior to general anaesthesia. In the recovery room, after an uneventful general anaesthetic, acute uvular oedema resulted in post operative airway obstruction and admission to hospital. The uvular oedema was treated successfully with dexamethasone. CONCLUSION: Recent inhalation of marijuana before general anaesthesia may cause acute uvular oedema and post operative airway obstruction. The uvular oedema can be easily diagnosed and treated.- - - - - - - - - - ranking = 0.33333333333333keywords = anaesthesia (Clic here for more details about this article) |
7/11. Sub-Tenon's anaesthesia: an efficient and safe technique.AIM: To evaluate sub-Tenon's anaesthesia as an alternative to peribulbar anaesthesia. methods: 109 consecutive patients listed for various eye operations (including cataract, trabeculectomy, and vitrectomy) under peribulbar anaesthesia were operated on under sub-Tenon's anaesthesia instead. After topical anaesthesia a buttonhole was fashioned through the conjunctiva and Tenon's capsule 10 mm posterior to the limbus. 1.5 ml of lignocaine 2% was then delivered to the posterior sub-Tenon's space using a blunt cannula. The surgical procedure was performed immediately after the completion of the anaesthetic procedure. Chemosis, conjunctival haemorrhage, degree of akinesia, and pain scoring were analysed. RESULTS: There were no anaesthesia related complications. The administration of the block was painless for 99.1% of the patients. In all, 97.3% reported no pain during surgery. There was no akinesia when assessed just after the completion of the block and akinesia was limited when assessed after surgery. Chemosis and conjunctival haemorrhage were frequent but caused no intraoperative problems. CONCLUSION: Sub-Tenon's anaesthesia is an efficient and safe anaesthetic technique. It is a good alternative to peribulbar anaesthesia.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
8/11. Prolonged cutaneous sequelae after intra-arterial injection of propofol.propofol is a popular drug for the induction of anaesthesia and sedation in the intensive care. Previous cases of inadvertent intra-arterial injection propofol injection have had no more than a few hours of hyperaemia. However in this case, residual cutaneous hyperaemia for 12 days were found after intra-arterial injection. This report also highlights the presence of an aberrant radial artery at a site that is used commonly for intravenous cannulation. Early suspicion should be aroused if the patient complains of pain on injection that is not abolished by lignocaine and if blanching of the hand is seen on injection. A useful precaution is establishing a running intravenous line before the administration of drugs. The literature concerning prevention and treatment of inadvertent intra-arterial injection is discussed.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
9/11. Bedside test for diagnosis of oedema fluid after extradural anaesthesia.PURPOSE: To consider and differentiate oedema fluid from other fluids in the performance of epidural block. CLINICAL FEATURES: A patient underwent placement of an epidural catheter for vaginal delivery of twins. Following a loss of resistance technique using air a small amount of fluid was aspirated through the needle and subsequently through the epidural catheter. The epidural block and delivery followed uneventfully. After delivery oedema fluid oozed from the puncture site for a number of days. Laboratory investigation revealed that this fluid was of oedematous origin. Bedside determination of alkaline pH by Combur 10 Test M urine stick appeared to be a simple and useful test for distinguishing the oedema fluid from fluids of other possible sources. CONCLUSION: When performing an epidural blockade the return of fluid may be due to oedematous fluid. Differentiation of the pH by a simple bedside test can aid in the differential diagnosis and prevent unnecessary additional attempts at needle repositioning.- - - - - - - - - - ranking = 0.66666666666667keywords = anaesthesia (Clic here for more details about this article) |
10/11. Inadvertent injection of sodium hypochlorite into the maxillary sinus.A previously undocumented complication of root canal therapy is reported. A dilute solution of 5-10 mls sodium hypochlorite was inadvertently injected into the maxillary sinus during root canal therapy of a right upper second premolar (5). The patient developed acute, sudden, severe facial pain and swelling necessitating emergency admission to hospital and operative intervention under general anaesthesia. A diagnosis of acute chemical sinusitus was made, further management and discussion follow.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
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